Quality of dying and quality of end-of-life care of nursing home residents in six countries

An epidemiological study

Lara Pivodic, Tinne Smets, Nele Van den Noortgate, Bregje D. Onwuteaka-Philipsen, Yvonne Engels, Katarzyna Szczerbińska, Harriet Finne-Soveri, Katherine Froggatt, Giovanni Gambassi, Luc Deliens, Lieve Van den Block

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Nursing homes are among the most common places of death in many countries. Aim: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. Design: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales – Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality. Setting/participants: Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident’s care. Results: Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales – Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14–42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11–55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales – Comfort Assessment while Dying score was associated with country (p = 0.027), older age (p = 0.012), length of stay ⩾1 year (p = 0.034), higher functional status (p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country (p < 0.001), older age (p < 0.001), length of stay ⩾1 year (p < 0.001), higher functional status (p = 0.002), absence of dementia (p = 0.001), death in nursing home (p = 0.033). Conclusion: The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.

Original languageEnglish
Pages (from-to)1584-1595
Number of pages12
JournalPalliative Medicine
Volume32
Issue number10
DOIs
Publication statusPublished - Dec 1 2018

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Terminal Care
Nursing Homes
Epidemiologic Studies
Quality of Life
England
Dementia
Long-Term Care
Italy
Belgium
Netherlands
Length of Stay
Confidence Intervals
Poland
Finland
Palliative Care
Nurses

Keywords

  • epidemiologic research design
  • Nursing home
  • palliative care
  • quality of health care
  • terminal care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Pivodic, L., Smets, T., Van den Noortgate, N., Onwuteaka-Philipsen, B. D., Engels, Y., Szczerbińska, K., ... Van den Block, L. (2018). Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study. Palliative Medicine, 32(10), 1584-1595. https://doi.org/10.1177/0269216318800610

Quality of dying and quality of end-of-life care of nursing home residents in six countries : An epidemiological study. / Pivodic, Lara; Smets, Tinne; Van den Noortgate, Nele; Onwuteaka-Philipsen, Bregje D.; Engels, Yvonne; Szczerbińska, Katarzyna; Finne-Soveri, Harriet; Froggatt, Katherine; Gambassi, Giovanni; Deliens, Luc; Van den Block, Lieve.

In: Palliative Medicine, Vol. 32, No. 10, 01.12.2018, p. 1584-1595.

Research output: Contribution to journalArticle

Pivodic, L, Smets, T, Van den Noortgate, N, Onwuteaka-Philipsen, BD, Engels, Y, Szczerbińska, K, Finne-Soveri, H, Froggatt, K, Gambassi, G, Deliens, L & Van den Block, L 2018, 'Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study', Palliative Medicine, vol. 32, no. 10, pp. 1584-1595. https://doi.org/10.1177/0269216318800610
Pivodic L, Smets T, Van den Noortgate N, Onwuteaka-Philipsen BD, Engels Y, Szczerbińska K et al. Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study. Palliative Medicine. 2018 Dec 1;32(10):1584-1595. https://doi.org/10.1177/0269216318800610
Pivodic, Lara ; Smets, Tinne ; Van den Noortgate, Nele ; Onwuteaka-Philipsen, Bregje D. ; Engels, Yvonne ; Szczerbińska, Katarzyna ; Finne-Soveri, Harriet ; Froggatt, Katherine ; Gambassi, Giovanni ; Deliens, Luc ; Van den Block, Lieve. / Quality of dying and quality of end-of-life care of nursing home residents in six countries : An epidemiological study. In: Palliative Medicine. 2018 ; Vol. 32, No. 10. pp. 1584-1595.
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AU - Pivodic, Lara

AU - Smets, Tinne

AU - Van den Noortgate, Nele

AU - Onwuteaka-Philipsen, Bregje D.

AU - Engels, Yvonne

AU - Szczerbińska, Katarzyna

AU - Finne-Soveri, Harriet

AU - Froggatt, Katherine

AU - Gambassi, Giovanni

AU - Deliens, Luc

AU - Van den Block, Lieve

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N2 - Background: Nursing homes are among the most common places of death in many countries. Aim: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. Design: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales – Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality. Setting/participants: Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident’s care. Results: Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales – Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14–42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11–55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales – Comfort Assessment while Dying score was associated with country (p = 0.027), older age (p = 0.012), length of stay ⩾1 year (p = 0.034), higher functional status (p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country (p < 0.001), older age (p < 0.001), length of stay ⩾1 year (p < 0.001), higher functional status (p = 0.002), absence of dementia (p = 0.001), death in nursing home (p = 0.033). Conclusion: The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.

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KW - palliative care

KW - quality of health care

KW - terminal care

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